Constipation or irregularity refers to the slowing down of the intestinal transit with consequent irregularities in evacuating. The treatment for constipation begins by identifying the causes of the disorder and therefore arrive at a correct diagnosis.
Constipation can in fact be caused by several factors and reveal itself with different symptoms. For this reason, especially in the case of chronic constipation, it is essential to seek medical attention.
During the examination the specialist will carry out an accurate medical history evaluating:
- the frequency of the evacuations
- the quantity of faeces produced
- the shape and texture of stools
- the difficulty at the time of evacuation
- a feeling of incomplete evacuation
- situations of strong tension or stress
- eating habits and lifestyle
Depending on the symptoms, the specialist may supplement the medical history and clinical examination with some diagnostic tests including:
- anorectal manometry: to evaluate the pressure exerted by the anal sphincters
- study of intestinal transit times: which would diagnose constipation due to slowed intestinal transit.
- colonoscopy: to examine the colon and identify abnormalities such as polyps, diverticula or tumour masses which could compromise normal intestinal transit.
This information will allow the proctologist to define the most appropriate therapy.
Constipation: prevention and nutrition
In the absence of specific diseases, some precautions can help prevent constipation:
- a fibre-rich diet which will soften the faecal mass and accelerate intestinal transit.
- a moderate consumption of foods with astringent properties such as lemon juice, boiled potatoes, rice.
- an adequate supply of liquids, which soften the faecal bolus and favour its expulsion.
- regular physical activity to promote bowel activity.
- adequate times and means of evacuation: following the stimulus to defecation and dedicating the right time to bowel functions helps to avoid dehydration of the faecal bolus.
- regular meals to help bowel regularity and well-being.
Risks and consequences of constipation
Constipation can have consequences for our health and highlight the onset of other anorectal disorders. The consequences and risks associated with constipation include:
One of the possible consequences of constipation is haemorrhoidal disease. Constipation is in fact one of the more common factors underlying the onset of haemorrhoids. Excessive exertion during evacuation causes congestion of the haemorrhoidal cushions. Inflammation of the haemorrhoids can become chronic and lead to the onset of haemorrhoidal prolapse.
- Anal fissures
In the presence of constipation, faeces are often hard and voluminous and difficult to evacuate. For this reason, they can cause lacerations of the anal canal mucosa during evacuation. The resulting pain leads to holding the defecation, resulting in further dehydration and hardening of the stool. This triggers a vicious circle which can lead to anal fissures becoming chronic.
- Swelling and abdominal tension
Swelling and abdominal tension are among the most common consequences of constipation. The faecal material which stagnates in the intestine creates swelling due to intestinal gases causing the abdomen to be sensitive to touch.
- Skin problems
Impurities in the skin and a dull complexion can be associated with periods of prolonged constipation. The body is in fact loaded with toxins which it cannot get rid of through evacuation.
- Fatigue and mood disorders
Our nervous system needs nutrients and mineral salts to function properly. These substances are absorbed by the blood during the digestive process. In the case of chronic constipation, the reduced absorption of nutrients and the increase of toxins in the body can promote fatigue and mood disorders.
- Urinary infections
The slowing down of peristalsis causes alterations in the intestinal bacterial flora. The latter can promote the growth of harmful pathogenic bacteria which may spread to the urinary tract causing infections.
Remedies for constipation
There are many remedies available on the market to fight constipation. Each of them acts with different action mechanisms:
- Bulk-forming laxatives (cellulose, agar, guar gum, bran): based on insoluble fibres, they increase the volume of the stool and soften it by absorbing water. To avoid bowel obstruction, it is essential to take them with an appropriate quantity of fluids.
- stimulant or contact laxatives (anthraquinones, senna glycoside, bisacodyl, phenolphthalein, etc.): based on active irritant ingredients which act on the intestinal walls increasing their contractions and thus favouring the advancement of the faecal bolus along the intestine. They can cause cramps and abdominal pains. These products must be taken only when needed and for limited periods.
- osmotic-saline laxatives (magnesium salts, polyethylene glycol, lactulose, sorbitol): they attract and retain water, giving the faeces a semi-solid or liquid consistency. If taken at high doses they have a rather rapid effect. They are not without contraindications, including tympanites and electrolytic alterations.
- emollient and lubricating laxatives (almond oil, Vaseline oil, liquid paraffin): they lubricate the intestinal walls and the faecal bolus promoting its expulsion.
All laxatives, if used incorrectly, can impair bowel function. Abuse of these products can irritate the colon walls and decrease their ability to contract independently. Furthermore, laxatives can reduce the absorption of medicines and nutrients. This is why it is important to use them only when strictly necessary and following your doctor’s advice.
Medicines which promote intestinal contractions and peristalsis (e.g. metoclopramide, linaclotide).
The side effects of this category of medicines vary according to the active ingredient. The main side effects for many of these drugs are headache, dizziness, drowsiness. Some prokinetics can also impair evacuation control and cause faecal incontinence.
Products based on emollient substances (e.g. glycerine) which soften the consistency of the faeces in the last section of the intestine, reducing the effort during defecation.
There are different types and sizes available, based on the size and volume of liquid introduced.
Micro-enemas have a more delicate action than common enemas and are better tolerated by children and by those who suffer from haemorrhoids, fissures or irritable colon.
Glycerine-based suppositories soften the faeces in the last section of the intestine, facilitating their evacuation.
These products are normally well tolerated. However, they may have some side effects including diarrhoea, anal irritation, nausea, tympanites. These products should only be used after consulting a doctor.
Laxatives, prokinetics, enemas, micro-enemas and suppositories should be used for short periods. Prolonged use of these remedies can in fact damage normal bowel function. Overuse of these remedies to alleviate constipation can make it impossible to evacuate without their aid.
However, there are supplements on the market which allow the intestinal balance to be restored naturally without the side effects associated with these products.
Dietary fibre supplements
According to the WHO, it is important to introduce at least 10 gr. fibres for every 1,000 kcal taken. Refined industrial products and incorrect eating habits can cause a lack of fibre. An insufficient fibre intake puts a strain on gut health.
If it is difficult to take fibre through the diet, specific dietary supplements can be used.
Fibre food supplements help restore intestinal balance without the side effects often associated with laxatives, drugs, enemas and suppositories. Fibre supplements can also be taken regularly even for prolonged periods.